Clin Endosc.  2014 Nov;47(6):516-522. 10.5946/ce.2014.47.6.516.

Stricture Occurring after Endoscopic Submucosal Dissection for Esophageal and Gastric Tumors

Affiliations
  • 1Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
  • 2Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea. srjee@inje.ac.kr
  • 3Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
  • 4Division of Gastroenterology, Institute of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 5Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 6Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 7Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  • 8Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
  • 9Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea.
  • 10Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
  • 11Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
  • 12Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea.
  • 13Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
  • 14Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  • 15Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea.
  • 16Center for Gastric Cancer, National Cancer Center, Goyang, Korea.

Abstract

Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric and esophageal cancer. Compared to endoscopic mucosal resection, ESD has the advantage of enabling en bloc removal of tumors regardless of their size. However, ESD can result in a large artificial ulcer, which may lead to a considerable deformity. Circumferential mucosal defects of more than three-fourths the esophageal circumference, long longitudinal mucosal defects (>30 mm), and lesions in the upper esophagus are significant risk factors for the development of post-ESD strictures of the esophagus. In the stomach, a circumferential mucosal defects more than three-fourths in extent and longitudinal mucosal defects >5 cm are risk factors of post-ESD stricture. If scheduled early, regular endoscopic balloon dilation is effective in controlling and preventing post-ESD stricture. Moreover, intralesional steroid injections or oral steroids can achieve remission of dysphagia or reduce the need for repeated endoscopic balloon dilation. However, further study is needed to improve the prevention of stricture formation.

Keyword

Stricture; Esophagus; Stomach; Endoscopic submucosal dissection
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